# Relaxed Glycemic Control and the Risk of Infections in Older Adults with Type 2 Diabetes

> **NIH NIH R56** · KAISER FOUNDATION RESEARCH INSTITUTE · 2022 · $400,000

## Abstract

Abstract
Professional society guidelines for treatment of type 2 diabetes (T2D) endorse a glycemic goal of hemoglobin
A1c (HbA1c) <7% for most nonpregnant adults to reduce the long-term risk of complications. However, for the
~12 million Americans ≥65 years of age who have T2D, current guidelines recommend individualized
management and relaxed glycemic control (i.e., HbA1c 7% to <9%) for patients with multiple comorbidities,
poor health or limited life expectancy. Recommendations for relaxed glycemic control are based on evidence
that intensive therapy has significant risks (e.g., hypoglycemia), treatment burden and cost, and that time to
benefit may exceed life expectancy in older patients. However, current guidelines fail to recognize the potential
for relaxed glycemic control to increase the risk of infection in older adults. Because a clinical trial of the effect
of relaxed vs. intensive glycemic control on infection is not feasible, we propose an observational study to
estimate the short-term risk of hospitalization for infection associated with relaxed glycemic control (HbA1c 7%
to <9%) compared with intensive glycemic control (HbA1c 6% to <7%). The proposed observational study will
use longitudinal data from 116,484 racially and ethnically diverse (62% minority) adults ≥65 years of age with
T2D who have HbA1c within the guideline-recommended range of 6% to <9%. The project will identify factors
associated with 12-month risk of hospitalization for infection among older adults with T2D (Aim 1); determine
rates and hazard ratios of hospitalizations for infection by levels of baseline HbA1c (Aim 2); and estimate the
independent (unconfounded) effect of relaxed versus intensive glycemic control on risk of hospitalization for
infection using propensity score-based overlap weighting and directed acyclic graph-informed multivariate
adjustment to mitigate potential confounding (Aim 3). Throughout the project period, we will work closely with a
Stakeholder Advisory Council of key operational and clinical health plan leaders to conduct ongoing review of
our research strategy, disseminate our findings and plan future implementation. The proposed research will
provide evidence needed to inform recommendations for safe glycemic goals in older patients with T2D and, in
particular, to understand the association of relaxed glycemic control and short-term risk of hospitalization for
infection.

## Key facts

- **NIH application ID:** 10686497
- **Project number:** 1R56AG074986-01A1
- **Recipient organization:** KAISER FOUNDATION RESEARCH INSTITUTE
- **Principal Investigator:** Andrew John Karter
- **Activity code:** R56 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2022
- **Award amount:** $400,000
- **Award type:** 1
- **Project period:** 2022-09-15 → 2024-08-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10686497

## Citation

> US National Institutes of Health, RePORTER application 10686497, Relaxed Glycemic Control and the Risk of Infections in Older Adults with Type 2 Diabetes (1R56AG074986-01A1). Retrieved via AI Analytics 2026-05-27 from https://api.ai-analytics.org/grant/nih/10686497. Licensed CC0.

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